Pacemaker surgery is not painful during the procedure itself. You’re given local anesthesia to numb the chest area and intravenous sedation to keep you relaxed, so you stay awake but comfortable throughout. The real discomfort comes afterward, during the first few days of recovery, and the intensity varies widely from person to person.
What You Feel During the Procedure
The initial injection of local anesthesia causes a brief burning or pinching sensation, similar to a dental numbing shot. Once the area is numb, you should not feel pain. You will likely feel pressure and a pulling or tugging sensation as the surgeon creates a small pocket under the skin of your upper chest to house the device. Some people also notice their heart rate briefly speed up when the leads (thin wires connecting the pacemaker to the heart) are being tested. These sensations can feel strange, but they aren’t painful.
Pacemaker patients generally need only small amounts of intravenous sedation alongside the local anesthetic. The sedative medications used tend to be short-acting, which means you won’t be groggy for long after the procedure ends. Some of these medications also have an amnesic effect, so you may not remember much of the experience at all. The entire implantation typically takes about one to two hours.
Pain in the First Few Days
The incision site will be sore once the local anesthesia wears off. For most people, this feels like a deep bruise or ache across the upper chest and shoulder. In a survey of 281 pacemaker and defibrillator patients published in the British Journal of Cardiology, the most common pain relief used was acetaminophen (used by 122 respondents), followed by ice (56 people) and anti-inflammatory medications like ibuprofen (45 people). About 17% of respondents needed no pain relief at all.
That said, experiences sit on a spectrum. Some patients describe the first night as the hardest, with soreness that over-the-counter medication barely touches. One patient in the survey described “a squeezing pressure and all over body pain” that required prescription pain medication every four hours for eight to ten days. Others found that ice packs and careful sleep positioning were enough to manage their discomfort. The first night tends to be the most uncomfortable, partly because finding a sleeping position that doesn’t put pressure on the implant site takes some trial and error.
Ice applied to the area is one of the most consistently helpful strategies patients report. Sleeping propped up slightly or on your back, rather than rolling onto the side with the device, also makes a noticeable difference.
Arm and Shoulder Restrictions
A significant source of ongoing discomfort isn’t the incision itself but the movement restrictions that follow. For at least three to four weeks, and sometimes up to six weeks, you’ll need to avoid raising the arm on the pacemaker side above shoulder level. Activities that strain the chest or upper arm muscles are off limits: no vacuuming, mopping, pushing a lawn mower, swimming, or swinging a golf club or tennis racquet.
These restrictions exist to prevent the newly placed leads from shifting out of position before scar tissue anchors them to the heart. A displaced lead can mean a second procedure to reposition it, so the restrictions are worth taking seriously. The tricky balance is that you do need to gently move your shoulder during this period. Keeping the arm completely still for weeks can lead to a “frozen shoulder,” where the joint stiffens painfully. Gentle, below-shoulder movements help maintain range of motion without risking lead displacement.
How Long Recovery Pain Lasts
For most people, the sharpest pain fades within the first week. Tenderness, stiffness, and a general awareness of the device under the skin can linger for several weeks as the tissue heals around the pacemaker pocket. The timeline varies by individual. Some people feel essentially back to normal within a week or two. Others deal with residual soreness, especially with certain movements, for a month or more.
One common frustration patients mention is that prescribed pain medication sometimes covers only three days, while discomfort extends well beyond that window. If over-the-counter options aren’t managing your pain adequately, it’s reasonable to contact your care team rather than just push through it.
Leadless Pacemakers and Pain
A newer type of pacemaker, called a leadless pacemaker, skips the chest incision entirely. Instead of placing a device under the skin with wires threaded into the heart, a tiny self-contained pacemaker is delivered through a catheter inserted in the leg and placed directly inside the heart. There’s no chest pocket, no incision near the collarbone, and no leads to worry about displacing.
A study of over 10,000 patients found that leadless pacemakers had a lower rate of in-hospital complications (7.2%) compared to traditional pacemakers (10.1%), and a significantly lower risk of device-related complications over the following two years. Not everyone is a candidate for a leadless device, as they currently work best for certain pacing needs, but they represent a less invasive option with a simpler recovery for those who qualify.
Signs That Pain Isn’t Normal
Some degree of soreness is expected, but certain symptoms suggest a complication rather than routine healing. Increasing redness, warmth, or swelling around the incision site can indicate infection. A firm, expanding lump under the skin near the device may be a hematoma, where blood collects in the pocket. Fever, drainage from the incision, or pain that gets worse rather than better after the first few days all warrant a call to your care team. Normal post-surgical pain follows a clear trend: it peaks in the first day or two and gradually improves from there. Pain that reverses that pattern is worth investigating.